Low Testosterone

What Causes Low Testosterone?

Low testosterone can be caused by many factors, all of which play out against the normal, steady decline in testosterone levels with age. Tumors on the pituitary gland (which controls testosterone production in the testicles), problems with the testicles themselves, injury, infections and being overweight can all cause testosterone levels to drop below normal. Excess body fat does this because testosterone is normally broken down in the body’s fat cells, so if you have a lot of fat, your body breaks down testosterone extra fast, leading to a deficiency. And, as mentioned above, abdominal or “belly” fat has a greater capacity to convert testosterone to estrogen than other types of fat. 

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Another risk factor for hypogonadism that has only recently come to light is diabetes. A strong relationship has been discovered between impaired glucose tolerance, which is a primary feature of diabetes, and low testosterone levels. It appears that the high blood sugar levels and/or low insulin levels characteristic of diabetes harm the cells in the testicles that are responsible for making testosterone. A recent study of 221 middle-aged men confirmed this finding: the men most likely to be diabetic also had the lowest testosterone levels.

The reverse may also occur: low testosterone levels may decrease insulin sensitivity to lower muscle mass, thereby making diabetes worse. Because diabetes, particularly adult-onset diabetes, has been steadily rising as a health problem in most developed countries, the prevalence of hypogonadism associated with this disorder will likely rise as well in the coming years. We’ve already seen a rise in a condition known as metabolic syndrome, which is a pre-diabetic state among men with low testosterone levels, abnormal lipid profiles, insulin insensitivity, and weight gain around their middles. In fact, one of the clearest signs of both low testosterone and a tendency toward diabetes is abdominal fat. If your waist is larger than 40 inches and you tend to carry excess wait in your middle, as opposed to your thighs or buttocks, you may be at risk for both conditions. 

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Can Testosterone Levels Be Raised?

Abnormally low testosterone — one of the major signals of an advanced biological clock — can safely be restored. Men on testosterone replacement therapy can realistically look forward to renewed interest in sex, improved erectile function, and (if they also exercise) larger and stronger muscles and reduced fat.

However, always bear in mind that the use of testosterone or any of the many products containing testosterone precursors by men with normal levels can be dangerous and will likely hurt their fertility. Before beginning testosterone replacement therapy, men should attend to all of the factors to improve their overall health and fitness.

Jason's Story

After his wife was checked out for fertility problems and nothing was found, Jason went in for a semen analysis.

“My wife was checked out first because, of course, it’s always the woman’s problem, right?” he says. “But it turned out it was me…I had no sperm and a low testosterone level.” 

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When he came to see me, I confirmed his testicular failure, and also found a testicular tumor that required removal of that testicle. That left Jason with even less ability to make testosterone.

Eventually, he and his wife had two children using in vitro fertilization and a technique for finding and injecting sperm directly into a woman’s eggs.

But Jason’s story isn’t about his wife’s successful delivery of healthy twins. It’s about the effects of the testosterone therapy that he has used now for five years. In order to treat Jason’s extremely low testosterone levels, he began a course of testosterone injections every two weeks.

“I was about 100 pounds overweight,” Jason says. “I had been through every diet in the book, and the weight always came back. But the testosterone gave me a boost of energy that I never had before and for some reason, to this day, it allows me to control my appetite.”

At my suggestion, Jason began eating a sensible, healthy diet and, once he began to feel the testosterone kick in, he began to exercise for the first time in his life.

“When people would talk about their endorphins kicking in and getting that high from exercise, I didn’t know what they were talking about,” Jason says. “But now I do. With the testosterone, your body feels high, like you’ve got huge energy. You’re not sluggish, you bounce out of bed, get your shower, and you want to get to work. It’s that kind of feeling. Mind you, sometimes it’s still drudgery to go to the gym, but once I’m there, I really enjoy it, whereas before I could never even dream of exercising like this.”

Jason lost more than 90 pounds. He could buy clothes off the rack for the first time instead of having them custom made. He became much more confident in himself and says he feels years younger.

“Did it change my personality?” he asks. “Maybe. But I lost 90 pounds at the same time, so is it the weight loss or the testosterone? I don’t know.”

Jason is president of a thriving small business. He recalls a time after he’d lost his weight and bought new clothes. He had a meeting with a customer who was threatening to sever its ties with his business.

“They were saying they didn’t want to work with us, but I lost my weight and went into that meeting with my new look, Gucci suit, hip, no tie, open shirt, but in a conservative sort of way, and it was completely different,” he says. “I turned the whole thing around. And they’re one of our biggest accounts now. Because the perception of me changed. I was no longer this person who looked overweight and tired. All of a sudden I was a person with much more confidence, and I’m more gutsy, more full of myself.”

Like most men who use testosterone replacement therapy, Jason notices a distinctly heightened sex drive, particularly in the first few days after an injection. Although he says he’s never had a problem with his erections, now, at 44, he has noticed that his erections are more robust and he’s more easily aroused with testosterone.

Jason uses his testosterone responsibly. He gets blood tests every six months to monitor his liver function and prostate health. Thus far, he is much healthier now than before he began. His cholesterol levels and blood pressure improved and are excellent. And he experienced an unexpected benefit: relief from panic attacks.

“My panic attacks were so severe that I couldn’t get on a plane without getting drunk and having my pills,” he says. “It got to the point that I couldn’t even be in open places. But I haven’t had an attack now in four years. I’m in control now…and that’s the problem with panic…you feel like a you’re out of control. The shot makes me feel like I’m in control.”

Of course, testosterone therapy, particularly with injections, isn’t without drawbacks. Jason, who tried but just can’t give himself an injection, must make regular visits to get his shots, which can be a problem when he travels.

“It’s a hassle,” he says. “You know, getting to the nurse, ‘which cheek will it be this week?’ It’s a pain in the neck.” He’s also not thrilled that he expects to continue this routine the rest of his life. Although new methods for delivering testosterone have been developed since Jason began his therapy, they don’t give him the levels he finds work best. Still, he says the hassle and discomfort are worth it.

“Heart disease runs in my family,” he says. “My dad died at 47. I was overweight and never would have lost that weight without the testosterone. Never. Now my cholesterol is incredible. I exercise hard at least three times a week. And isn’t it healthier and better to be like this than to have been going on the track I was going before, which I’m sure would have led to a serious problem?” 

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